L3031 Foot lamin/prepreg composite

Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, each

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for L3031

DMEPOS fee schedule, July 2026 (DME26-C)

Payer policies and prior authorization for L3031

2 of 2 payer prior-auth lists that name L3031 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Rocky Mountain Health Plans.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025

Payer coverage policies that name L3031

L3031 appears in 6 coverage policies from Aetna, Anthem, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaBunionectomy (0629)listed, no stance (range L3000-L3100)Sep 11, 2026payer document
AetnaFoot Orthotics (0451)covered if criteria are met (range L3000-L3031)Jul 16, 2026payer document
AetnaPedobarography (0294)listed, no stance (range L3000-L3649)Apr 17, 2026payer document
AetnaPlantar Fasciitis Treatments (0235)listed, no stance (range L3000-L3265)Apr 27, 2026payer document
AnthemOrthopedic Footwear (CG-DME-20)covered if criteria are met (range L3000-L3031)May 14, 2026payer document
CignaOrthotic Devices and Shoes (0543)covered if criteria are metSep 15, 2026payer document
CignaOrthotic Devices and Shoes (0543)not coveredSep 15, 2026payer document

Recent prior-auth changes

  • Jul 1, 2026: PA removed, HealthSpring

Medicaid fee-for-service

Prior authorization required or conditional in CO, IL, MA, MS, NY, VA, WA, WV.

  • AZ: $123.09 (dme), effective Oct 1, 2026
  • CO: $124.29 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $111.22 (dme), effective Jan 1, 2026
  • IN: $125.43 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
  • KS: $119.82 (default), effective Jul 1, 2026
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MA: $128.87 (orthotics_prosthetics_rates), effective Apr 1, 2024
  • MD: $124.88 (dme), effective Apr 1, 2026
  • MS: $121.06 (comprehensive), effective Jul 1, 2026
  • NY: $101.91 (dme), effective Jul 1, 2026
  • OH: $119.73 (dme), effective Jan 1, 2026
  • OK: $105.92 (dme), effective Jan 1, 2026
  • TX: $116.10 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Oct 1, 2014
  • VA: $132.23 (dme), effective Dec 1, 2026
  • VT: $123.15 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $114.75 (prosthetics_orthotics), effective Jul 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.